title: Long-term, low-dose erythromycin in bronchiectasis subjects with frequent infective exacerbations.
abstract: BACKGROUND
  Macrolide antibiotics are increasingly prescribed for subjects with non-cystic fibrosis (CF) bronchiectasis, an empiric extension of their proven efficacy in CF. Widespread, injudicious use of long-acting macrolides, particularly azithromycin, risks significantly increasing population antimicrobial resistance.
  
  
  METHODS
  In an attempt to power a definitive randomised-controlled trial (RCT), an uncontrolled evaluation of the impact of long-term, low-dose oral erythromycin therapy upon pulmonary exacerbation frequency in non-CF bronchiectasis subjects was performed. Adult bronchiectasis subjects with at least 2 infective exacerbations in the preceding 12 months were followed for 12 months following commencement of prophylactic oral erythromycin 250 mgs daily. The co-primary outcome measures, comparing the 12 month erythromycin and pre-erythomycin periods, were numbers of infective exacerbations and days of antibiotic therapy for infective exacerbations.
  
  
  RESULTS
  In the 24 evaluable subjects completing a minimum of 12 months of therapy, erythromycin was associated with halving of both the median (range) annual number of infective exacerbations (2 (0-8) vs. 4 (2-11), 95% CI 1.5 to 3.5, p < 0.0001) and annual days of antibiotic use (21 (0-78) vs. 44 (15-138), 95% CI 18 to 40, p < 0.0001) compared with the preceding 12 month period.
  
  
  CONCLUSIONS
  Low-dose erythromycin may have a robust effect upon exacerbation frequency in non-CF bronchiectasis subjects with frequent exacerbations and this warrants proceeding to a definitive intervention study. These data have enabled powering of an RCT of long-term, low-dose erythromycin, which is now underway and also incorporates bronchoscopic evaluation for pathophysiologic data.
authors.affiliation: Dept. of Respiratory Medicine, Lvl 9, Mater Adult Hospital, Raymond Tce, South Brisbane, Qld. 4101, Australia. david.serisier@mater.org.au
authors.forename: D J
authors.initials: DJ
authors.lastname: Serisier
authors.forename: M L
authors.initials: ML
authors.lastname: Martin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001987:Bronchiectasis / Q000188:drug therapy* / Q000503:physiopathology; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004917:Erythromycin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D000900:Anti-Bacterial Agents; D004917:Erythromycin